Tuesday, March 29, 2016

Step 2 CS: Noisy breathing

I think mnemonics aren't required for every case if you have the correct thought process, you will ask the right questions.
Found out what is the patient talking about:
Onset
Progression
Duration
Description
Alleviating / Aggravating factors (especially positional)
Heard on inhalation or exhalation

Noisy breathing, what are the differentials?

Foreign body aspiration
- What was she doing before the noisy breathing started?

Infectious etiology
- Fever / chills / night sweats
- Cough / Sputum / Blood 
- Difficulty breathing / pulling of ears

Epiglottitis
- Is there drooling of saliva from the mouth?
- Is the cry muffled?

Croup
- Is the cough barking in nature?

Laryngitis
- Hoarseness of voice

Angioedema
- Allergies in the family / Is the child allergic to anything?
- Has she had many infections in the past?

Assess how severe is the difficulty breathing
- Is there cyanosis?
- Is she crying? How is the cry?
- Is she awake / unusually sleepy?
- Is there any difficulty feeding?

Sometimes, children aspirate foreign bodies to gain attention from parents on purpose
- Any similar episodes in the past?
- Any stress in the family?

Other questions:
Snoring for adenoids?

Labs: 
ABG
CXR
XR neck
Bronchoscopy / Laryngocopy

That's all!

-IkaN

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